高血压患者门诊药物治疗血压达标的影响因素

目的 了解现实治疗状况中,对高血压患者在门诊药物治疗中,影响血压控制达标的相关因素.方法 对1012例来本院申请办理医疗保险高血压慢性病门诊的患者进行回顾性调查,分别记录患者的年龄、性别、患病年限、历史最高血压、当前血压、当前用药种类、随诊科室等情况.并统计达标率,分析在各科室或机构就诊患者的达标率；分析达标患者中各种药物的使用比例及联用情况；应用Logistic回归分析得出门诊高血压患者长期血压控制达标的影响因素.结果 患者平均年龄（66.2±10.9）岁,男357例,女655例,平均高血压患病时间（11.1±9.7）年,总体达标率34.4％,达标患者主要集中在心血管专科就诊,占71.2％；该人群中以钙离子拮抗剂（CCB）的使用率最高,1、2、3级高血压患者的使用率分别为62.1％、88.9％、80.8％；β受体阻滞剂（β-B）次之,分别为37.9％、58.3％、60.3％.1级血压达标患者51.7％单药治疗；随着血压水平升高,达标患者联合治疗比例增高：2、3级高血压患者分别为76.4％、85.9％；在2种药物组合中,最常被选用的联合是CCB和β-B,占44.4％,其次是CCB和血管紧张素受体拮抗剂（ARB）,占15.9％.Logistic回归分析显示：在心内科专科随诊、使用CCB是血压达标的独立促进因素（OR和P值分别为：14.49,0.019；1.95,0.005）.既往最高收缩压是影响达标的不利因素（OR =0.98,P=0.017）.结论 要高血压患者门诊药物治疗血压达标,应该定期在心血管专科门诊随诊以调整治疗方案,中度以上高血压患者应采取联合治疗,并应用以CCB为基础的联合治疗方案.

Impact factor of blood pressure controlling in long-term medical therapy for outpatients with essential hypertension

Objective To research the impact factor of blood pressure controlling in long-term medical therapy of the real world.Methods We retrospectively studied 1012 outpatients with essential hypertension who applied for medical insurance.We recorded their information include age,sex,duration with hypertension,the historic highest blood pressure,the sorts of blood pressure lowering agent,follow-up department,and so on.We calculated the controlling ratio of different pressure-level,the total patients and different follow-up situation of patients.We analyzed the proportion of various kinds of blood pressure lowering agent and the information of combination therapy in the controlled patients,then exported the impact factor of blood pressure controlling in long-term by Logistic regression analysis.Results Of （66.2 ± 10.9） mean age patients included 357 male and 655 female,its average duration with hypertension were（11.1 ± 9.7） years.It had 13.9％,38.4％,47.7％ patients in 1 to 3 blood pressure level respectively.Total controlled ratio was 34.4％.The patient controlled ratio of cardiovascular department,endocrine,clinic of general medicine or community,oneself-treated and non-treated were 71.2％,17.4％,22.6％,11.3％,0 respectively.Calcium-channel blocker（CCB） was most used in blood pressure controlled patients,the second was β blocker,and the third was angiotensin receptor antagonist （ARB）.The results of logistic regression analysis showed that,the independent facilitative factor for the patients＇blood pressure controlling were followed-up in clinic of cardiovascular department,and treated by CCB （odd ratio and its P value were 14.49,0.019;1.95,0.005）.The prior highest systolic blood pressure was a disadvantage to the goal blood pressure （OR：0.98,P：0.017）.Conclusions Patients with essential hypertension were followed up and treated in cardiology outpatient-department consistently,using CCB as a basis treatment or a basis of combination,is the value key to make Chinese outpatients to reach the goal blood pressure in long-term medical therapy.